BS Medical Billing, what can I do about it?

[Anonymous]

Hi all,

It's been a while since I've posted on here, life's been getting busy!

Around this time last year, I had an accident and would up in surgery, but this post isn't about me.  

I found a "great" physical therapy location and recommended them to my girlfriend.  She went to her doctor and got authorized by her insurance for 12 visits.  At this time, they decided that it would be a good idea to continue on with the visits.  They asked her to go get a new authorization from her doctor.

From what I can gather, concurrently, they sent for an authorization (I'm not sure why).  This was approved.  Unfortunately, shortly after the approval, my girlfriend's doctor submitted for an authorization, which was also approved and overrode the physical therapist's authorization.  The mess up is that the doctor sent for the approval to the wrong location.  We were never informed that her approval to this physical therapy location was no longer valid, and now we're being billed for it.  We've written a grievence to her insurance and we're not 100% sure of the outcome of this grievence.  

My issue is as follows:  she would have never gone to physical therapy if she knew she had to pay out of pocket.  It's absurd that the physical therapist is able to bill her for more than $750 after telling her she's approved and her insurance covers it.  I liken it to winning a TV in a contest, then 2 months later being billed for it.

Is this legal?  What can we do about it?  Again, she followed everyone's directions completely.  She never received paperwork telling her that the location of her authorization had changed, and in her 12 visits, no one told her she was no longer authorized.  I feel that we would have a strong case in small claims court, but I would rather not have to go to court over this.  Any and all advise is appreciated.  Thanks.

[RobertEG]

Whether or not a given debt is legit or "legal" is, if it remains contested after a dispute under the FCRA, ultimately determined by the courts.

The FCRA dispute process does not compel both sides to produce all evidence, does not require documention to "prove" a verification,  and does not have a judge to make a decision on contested issues.

You file a dispute asserting inaccuracy in the debt, along with your documentation and arguments.  The furnisher must then condect a "reasonable investigation" of the dispute and provide a finding back to the CRA or to the consumer.  That finding is not required to legally "prove" their verification.

You may need to file a civil action if the issue cannot be resolved administratively via the limited FCRA dispute process.

If a medical debt is ultimately paid via a medical insuror, then it will be removed from your credit report.

The Big-3 CRAs signed a consent decree in 01/2015 with the office of the AG's of several states, and subsequently published the terms of that agreement in a policy plan.

[tacpoly]

This should be an issue with the insurance, first and foremost. Explain that your PT obtained preapproval and your girlfriend proceeded with the service not realizing it was transfered to a different location. It was an administrative mistake.